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Author
Topic: Re-infection! (Read 24511 times)

Honestly, the whole time I've had HIV, re-infection or superinfection is something that never even crossed my mind. That may well have been a mistake. For one thing, it definitely happens; the articles here http://www.thebody.com/index/treat/superinfection.html cite several cases in which it has clearly happened. Now it may have happened to me.

One Sunday afternoon around three weeks ago I became suddenly very ill. Chills and fever came out of nowhere and lasted for about two days. Headache and muscle aches lasted a couple of days longer. Then I was fine again, and then after a few days I suddenly had no energy. I slept for around twenty hours a day for three days and hardly wanted to eat anything for a week. One silver lining: I lost twelve pounds!

In the middle of all this I had my regularly scheduled HIV blood tests. Two days later my doctor called me and asked me to go in for further blood tests. The next day she called again and asked me about recent sexual activity. She said that it looked as if I had been reinfected with HIV!

Now, I'd only had sex once recently, and it was with condoms. But a strange thing happened in the middle of that episode. At a moment when I had my back to the guy, I suddenly thought "Did he just pull out, pull off the condom, and go back in?" Then I though, "No, that's silly." After a moment we changed position and I saw him put on a fresh condom. Now it looks likely that my suspicion was founded on something after all.

The reason my doctor thinks re-infection is likely is the wildly high Viral Load. There are also some slight liver abnormalities. Another thing that has happened is I've recently been infected with cmv. Apparently a lot of people with cmv don't have any symptoms at all, but some get a flu-like illness which could be why I got sick--or it could be that I went through acute HIV all over again, which has happened with people who got re-infected. The VL could be explained by cmv: the immune system was so busy fighting cmv that the HIV took the opportunity to go berserk; but 799,000 seems a bit extreme, which is why my doctor is leaning towards superinfection as an explanation. The very low cd4% is explained by dramatic increases in helper cells which may be a result of the cmv as well.

The possible results of re-infection are:

1. going through acute HIV all over again;2. possibly acquiring new drug resistances; and3. possibly getting a more lethal strain of HIV and progressing faster.

I already seem to have been through one; I'll find out in a week whether two is my case or not, when drug-resistance tests results come back. But for three only time will tell.

Whether re-infection is what's happened to me or not, please be aware of the possibility! The whole thing came as such a shock to me because I'd never even thought about it. I honestly didn't want to write this but I think it is important to warn others of the possibilities. Thanks for reading, and please, be careful!

"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

sorry to hear about this Nestor. Could this possibly be just a lab error? Are you having lab work, not just genotyping, done again to verify this? I know I would with such an out-of-the-ordinary change like that.

Here's hoping, if it's not just an error, that at worst it's just #1 and none of #2 or #3

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

Now, back to the OP, I will have to agree with Mr. Bivins, you may need additional labs to figure out what's going on here. As far as super-infection is concerned there will be others who are more enlightened on this subject.

I would just caution those who are somewhat newly infected when they read this thread to not become totally paranoid about this subject. There is a lot more to it than what's being presented here, and there are some who are quite skeptical about the fact that it happens commonly [or at all]. Again, it is a topic that those with more knowledge will hopefully address in a proper manner.

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"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

I know the super infection issue is a hot button subject. I've heard some say it is always a possibility and others say it only happens to people newly infected. To someone still learning about all this, I think why couldn't you get infected again with a different strain? It appears to be rare, isn't it?

About the CMV infection-- I thought we really only had to worry about that at lower CD4s. Your numbers have been high. Is it uncommon to get OI's with higher numbers? You're not on meds? I'm not either and this is something I've asked about--whether not being on meds but with good numbers puts me at higher risk for OI's than HIVers on meds.

Reinfection and "superinfection", which I assume to mean two different things, are not well researched, so it's kind of surprising to me that your healthcare providers would immediately make that association and informing you so without going through all other possibilities, including as simple and harmless as a lab test fail.

Or have they already ruled out other explanations? For example, have they checked you with other STDs that are very easy to catch but curable, like syphilis? There are many researches concluding that syphilis can cause VL spikes, and all those reinfection symptoms you mentioned could also happen to someone who's going through the primarily or secondary stage of syphilis.

As for CMV, most of us already have it (as much as 85% of the total population by some estimates) but our immune systems mostly keep it in check. But when one's immune defenses are weak, it comes out to attack and kill us like a number of other opportunistic infections (PCP, etc). And like PCP no additional preventive meds are needed unless our CD4 has dropped below 100 or unless one is already suffering from a form of CMV illness like retinitis.

So, the chance is that you are already CMV reactive long before you found out about it recently. But since you said your infection is recent, do you mean that you were tested before and had a confirmed result that you didn't have CMV, but that a recent one shown that you have?

Because as far as I know nobody cares to test for CMV because it rarely causes health problems, not even pozzies like us because the chance is that, like the general population, we already have it, and if we're having a good CD4 number it also rarely causes any troubles. And even if it was a recent infection, primarily CMV also rarely caused any symptoms, and even when they show up they are non-specific and mild... not something that could explain the VL spike. So, in short, don't see how it's relevant to your situation.

Seriously, just trying to be helpful, and I would in particularly recommend you to ask for a full STD panel.

sorry to hear about this Nestor. Could this possibly be just a lab error? Are you having lab work, not just genotyping, done again to verify this? I know I would with such an out-of-the-ordinary change like that.

Here's hoping, if it's not just an error, that at worst it's just #1 and none of #2 or #3

My doctor did mention the possibility of a lab error, except that a mere error wouldn't just happen to take place at the same moment that I become seriously ill. One possibility she mentioned is that the presence of cmv or antibodies to cmv may have messed up the HIV VL reading.

At any rate, I am indeed getting tested again on July 13, and will find out those results on Aug. 2nd--not quite soon enough for my taste but better than waiting 3 months. There's something about knowing I have a 799,000 VL that's really making me uncomfortable!

I would just caution those who are somewhat newly infected when they read this thread to not become totally paranoid about this subject. There is a lot more to it than what's being presented here, and there are some who are quite skeptical about the fact that it happens commonly [or at all]. Again, it is a topic that those with more knowledge will hopefully address in a proper manner.

I certainly don't advise anyone to be paranoid, but what is the lesson to be drawn from this? I made a conscious choice only to have protected sex, for my sake and for that of my partners. And STILL this kind of crazy thing can happen! So what is the lesson--only have sex with people you know well and trust, who won't randomly pull a condom off in the middle of sex? Or just live with the possibility that this can happen? I'm paranoid now! I think I'm going to be terrified to have sex after this!

As for reinfection, or superinfection (they do appear to be two names for the same thing) I think everyone who has HIV would do well to read a few of the more recent articles in that page of articles to which I linked in my original post. It's something we ought to be aware of. It obviously happens; that has been proven. How common it is is unclear; one study suggested 4 or 5 percent of people with HIV. In another study, out of eight people, two were clearly reinfected. In one case it was a good thing: the guy's original virus had some med resistances, and after reinfection the new strain did not have any! Still, if I'm understanding correctly, reinfection happens when the new strain of the virus is somehow stronger than the old strain--the new strain conquers and replaces the old strain--and that makes me nervous. If I've just been reinfected, I"m wondering what this new strain is going to be like to live with.

Ted, if the illness of the past three weeks is indeed a response to CMV, and not just reinfection, I don't think it is technically an OI. Here's what Wikipedia says about CMV:

"Most healthy people who are infected by HCMV after birth have no symptoms.[1] Some of them develop an infectious mononucleosis/glandular fever-like syndrome,[5] with prolonged fever, and a mild hepatitis."

So most healthy people who get infected with CMV do not get this fever, but some do, and I may have been one of the lucky ones; that might have happened even to someone without HIV. I think CMV is an OI when people with VERY few t-cells go blind from it or have other serious results: my doctor spent some time today reassuring me that I would have to have around ten t-cells before that kind of thing could happen.

Komnaes , when my doctor saw my lab results--not only the VL but also the liver abnormalities--she immediately had me tested for Epstein-Barr, CMV, and Hep C. (Presumably the issue of syphillis has not been raised as it would not explain the liver issues? I'm not sure myself, but surely there must be a reason why my doctor did not mention syphillis as a possibility? Besides, I certainly didn't see anything like a chancre.)

These tests were very specific and designed to tell, based on antibodies, whether an infection was recent or old. With Epstein-Barr, it turned out that I have been exposed to it at some point in the past, but not recently; with CMV it was the opposite: a recent first infection. I'm not clear whether it is the number or the type of the antibodies that helps determine these things. CMV could explain both the illness and the liver abnormalities, to the extent that one almost wouldn't need to keep entertaining the re-infection possibility, except for that bizarrely high VL. Hopefully the next set of labs will put that in some perspective.

As for CMV, most of us already have it (as much as 85% of the total population by some estimates) but our immune systems mostly keep it in check. But when one's immune defenses are weak, it comes out to attack and kill us like a number of other opportunistic infections (PCP, etc). And like PCP no additional preventive meds are needed unless our CD4 has dropped below 100 or unless one is already suffering from a form of CMV illness like retinitis.

So, the chance is that you are already CMV reactive long before you found out about it recently. But since you said your infection is recent, do you mean that you were tested before and had a confirmed result that you didn't have CMV, but that a recent one shown that you have?

Because as far as I know nobody cares to test for CMV because it rarely causes health problems, not even pozzies like us because the chance is that, like the general population, we already have it, and if we're having a good CD4 number it also rarely causes any troubles. And even if it was a recent infection, primarily CMV also rarely caused any symptoms, and even when they show up they are non-specific and mild... not something that could explain the VL spike. So, in short, don't see how it's relevant to your situation.

Actually, it is estimated that 99% of all gay men are infected with CMV, which is indeed normally controlled by CD4s over 50. It is exceptionally easy to transmit, usually via......dare I say the word?......saliva.

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"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Komnaes , when my doctor saw my lab results--not only the VL but also the liver abnormalities--she immediately had me tested for Epstein-Barr, CMV, and Hep C. (Presumably the issue of syphillis has not been raised as it would not explain the liver issues? I'm not sure myself, but surely there must be a reason why my doctor did not mention syphillis as a possibility? Besides, I certainly didn't see anything like a chancre.)

Actually, syphilis can attack the liver. Consider that an unsafe sex accident might have happened (and syphilis and other STDs can be transmitted through unprotected oral), I still find it surprising that your care providers did not mention that possibility.

It's up to you my friend.. but my suggestion is still to ask for a STD panel.

PS- modified to add that chancre and other secondary rashes could appear in places that are hard to see, and many people missed them during the critical early period

These tests were very specific and designed to tell, based on antibodies, whether an infection was recent or old. With Epstein-Barr, it turned out that I have been exposed to it at some point in the past, but not recently; with CMV it was the opposite: a recent first infection.

This portion of your post, coupled with Occam's Razor, points to you experiencing a primary CMV infection and not reinfection. And yes, reinfection and superinfection are the same thing.

You had your recent blood tests "in the middle of all this", so why is the high viral load so mysterious? And why couldn't a "mere error" be a coincidental happening? Shit really does happen, you know.

edited because I can really strangle me some syntax when the mood strikes

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

This portion of your post, coupled with Occam's Razor, points to you experiencing a primary CMV infection and not reinfection. And yes, reinfection and superinfection are the same thing.

You had your recent blood tests "in the middle of all this", so why is the high viral load so mysterious? And why couldn't a "mere error" be a coincidental happening? Shit really does happen, you know.

edited because I can really strangle me some syntax when the mood strikes

I believe the difference is between reinfection and coinfection (although reinfection can cause coinfection) reinfection is where someone who has been hiv+ for a while supposedly is infected with another strand of the virus whereas coinfection is 2 infections simultaneously either during the first infection or eventually when you are reinfected you are then considered coinfected.

I believe the difference is between reinfection and coinfection (although reinfection can cause coinfection) reinfection is where someone who has been hiv+ for a while supposedly is infected with another strand of the virus whereas coinfection is 2 infections simultaneously either during the first infection or eventually when you are reinfected you are then considered coinfected.

Run on sentences yay. Superinfection and coinfection are synonymous.

Crikey. Why don't you just come out and say you don't know? Or just leave it? Your above post is gobbledegook and is only going to confuse people further.

Coinfection and Reinfection

Researchers make a distinction between two types of dual, or multiple, HIV infection:

Coinfection, or infection with more than one viral strain at or near the same time, is believed to occur around the time of initial infection. (Initial infection is also known as acute or primary infection -- the period before seroconversion that usually lasts from a few weeks to a few months.)

Reinfection with a different strain, also known as superinfection or serial infection, presumably takes place later on during early infection (the first few years of HIV disease, after seroconversion) or chronic (long-term) infection.

In theory, any apparent case of reinfection could be a case of coinfection in which one of the coinfecting strains remains undetectable until it emerges sometime after seroconversion (the point at which HIV antibodies can be detected and a person can be diagnosed as being HIV positive). This is sometimes called sequentially expressed coinfection. Testing limitations that prevent detection of very small viral populations in the body make it difficult to distinguish between coinfection and reinfection. Researchers believe that until a source partner for dual infection is found and the timing of exposure confirmed, it is not possible to determine that the second virus was acquired after seroconversion.

While finding source partners is a continual problem, determining the timing of exposure is aided in some cases by the emergence of acute retroviral syndrome (often flu-like symptoms, including fever and fatigue) in the person presumed to be reinfected. It is not known whether overgrowth of a previously dormant coinfecting strain might also trigger acute retroviral syndrome. source

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

except that a mere error wouldn't just happen to take place at the same moment that I become seriously ill.

ROFL dude, never take it for granted that 2 (or 3 or 4 or more) weird things couldn't all happen at the same time. A lab error at the time of me being sick would be exactly like the kind of crazy incidents that happen in my life.

Unfortunately without more info, you're just going to have to hang in there and wait to see what all the lab work points to in Aug. (which kinda shows that your doctor isn't as concerned as you are about this anomalous reading)

How are you feeling now? Hopefully better!And hopefully you'll be feeling better when you have this next batch of new tests done - otherwise you might get another batch of screwy tests back. LOL

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

Komnaes, I would be happy to ask my doctor whether she thinks testing for syphillis would be a good idea. I guess basically I trust her enough that if she didn't suggest syphllis, she must have had a reason for not suggesting it. Plus, now with cmv, there's sort of already an explanation for most of what happened, or even all as Ann suggests....

This portion of your post, coupled with Occam's Razor, points to you experiencing a primary CMV infection and not reinfection. And yes, reinfection and superinfection are the same thing.

You had your recent blood tests "in the middle of all this", so why is the high viral load so mysterious? And why couldn't a "mere error" be a coincidental happening? Shit really does happen, you know.

edited because I can really strangle me some syntax when the mood strikes

Funny, I actually thought about Occam's razor this morning when I was thinking about this. If a primary CMV infection is enough to explain everything, then why the re-infection theory? And Edfu points out that CMV is easy to transmit, even with saliva. Re-infection in this case needs to suppose that the guy actually did pull the condom off and that in the few short moments before he put a new one on I got reinfected. (On the other hand, if 99% of gay men have CMV, and if it's transmitted as easily as that, it's strange that I went to age 36 before finally getting it.)

But I suppose the high viral load is the center of the mystery here. Yes, I know that when people get sick their VL goes up, but that much? Has anyone else here had anything like that kind of rise? If so, under what circumstances? From 4,000 to 799,000? I know that that is what first suggested reinfection to my doctor--the vl looked like the rampant vl of someone who's just sero-converted. Actually, it would be reallly helpful to know how common this sort of thing is, and why it happens--lab error, illness, etc....

I sure wish it were August 2nd already--I feel like I have spiders running amok inside me.

One think for CMV--it's the most amazing rapid weight-loss mechanism the world has seen! I started eating normally two days ago, and I still weigh a pound less today than I did yesterday! Sorry, it's the one bright spot to cling to in the gloom....

ROFL dude, never take it for granted that 2 (or 3 or 4 or more) weird things couldn't all happen at the same time. A lab error at the time of me being sick would be exactly like the kind of crazy incidents that happen in my life.

Unfortunately without more info, you're just going to have to hang in there and wait to see what all the lab work points to in Aug. (which kinda shows that your doctor isn't as concerned as you are about this anomalous reading)

How are you feeling now? Hopefully better!And hopefully you'll be feeling better when you have this next batch of new tests done - otherwise you might get another batch of screwy tests back. LOL

Leatherman, I just posted the above when your response came in. Thanks! Sure, I guess just being patient is the only thing. My doctor wanted to test again in one month; I suppose testing again immediately would be useless, because if this is a result of sickness, I'm still sick. July 13 was the closest available day; I have to wait until August 2nd because I think my doctor will be on vacation in the end of July, but two weeks is usual anyway.

I'm feeling better, physically, every day, although still have very low energy--I still slept for about twelve hours yesterday. Emotionally, I'm feeling creepy about this new VL, plus having yet another virus lurking in my system waiting to do who knows what someday.

Remember the thread in which I said that I always had my labs done in the evening, and now one was being scheduled for the morning, and I was afraid the t-cell count would look abnormally low because of diurnal variation? That turned out to be the least of my worries! In fact, the t-cell count is the only thing that came through unscathed!

Funny, I actually thought about Occam's razor this morning when I was thinking about this.

Oooo... spooky... you may have been channelling me. Better get checked out for AIDSmeds related dementia, just in case.

Sorry couldn't resist.

It never hurts to get checked out for syphilis. It's spread through skin-to-skin contact and therefore a lot easier to contract - sometimes even when condoms are being used. As the chancres are not painful, they aren't always noticed. And it's not called the great imitator for nothing - it can imitate other illnesses.

While it's unusual for a person of your age to not previously had CMV, it happens. After all, it's not 100% of the population who will test poz - and I'm pretty sure the gay man estimate % edfu gave out is too high. What I've read has been more in the 75% range.

But what I'm trying to say, somebody has to be in the percentage of people who won't test positive for CMV and up until recently, why couldn't that person be you?

It sounds like you were pretty ill with the CMV - it could well have cause a huge blip in your VL. Or it could be lab error. This seems to be how your doctor is thinking - why not just go with it? You're not going to speed your tests along by driving yourself mad and continually fretting about this.

And think of all the CD4s you're going to be drowning in that sea of worry. Stress ain't good for you!

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

While it's unusual for a person of your age to not previously had CMV, it happens. After all, it's not 100% of the population who will test poz - and I'm pretty sure the gay man estimate % edfu gave out is too high. What I've read has been more in the 75% range.

A couple of relevant references:

"The prevalence of CMV infection in homosexual men is quite high (95%) as defined by antibody seropositivity. Moreover, there is frequent reactivation or reinfection with CMV in homosexual men, as evidenced by the presence of anti-CMV immunoglobulin-M in blood and excretion of the virus." --"Enhanced Shedding of CMV in Semen of HIV-Seropositive Homosexual Men," J. of Clin. Microbiol., May 1992

"Antibody to CMV was measured in the sera of 139 homosexual and 72 heterosexual men attending [a venereal disease clinic] and in 103 male volunteer blood donors. Titers were found in 94% of homosexual patients but in only 54% of heterosexual patients and 43% of male volunteer blood donors." --"Prevalence of CMV in Homosexual Men," J. Infect. Dis., Feb. 1981

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"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

"The prevalence of CMV infection in homosexual men is quite high (95%) as defined by antibody seropositivity. Moreover, there is frequent reactivation or reinfection with CMV in homosexual men, as evidenced by the presence of anti-CMV immunoglobulin-M in blood and excretion of the virus." --"Enhanced Shedding of CMV in Semen of HIV-Seropositive Homosexual Men," J. of Clin. Microbiol., May 1992

"Antibody to CMV was measured in the sera of 139 homosexual and 72 heterosexual men attending [a venereal disease clinic] and in 103 male volunteer blood donors. Titers were found in 94% of homosexual patients but in only 54% of heterosexual patients and 43% of male volunteer blood donors." --"Prevalence of CMV in Homosexual Men," J. Infect. Dis., Feb. 1981

"CMV is more prevalent in populations at risk for HIV infection; approximately 75% of injection drug users and >90% of homosexual men who are infected with HIV have detectable IgG antibodies to CMV. Higher prevalence rates among homosexual men correlates with the increased risk of exposure associated with receptive anal intercourse. In addition, high prevalence rates of CMV IgM antibody in longstanding CMV-seropositive homosexual men suggest that this group is frequently re-exposed to (and at least sometimes reinfected with) differing exogenous strains of CMV."

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"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

"CMV is more prevalent in populations at risk for HIV infection; approximately 75% of injection drug users and >90% of homosexual men who are infected with HIV have detectable IgG antibodies to CMV. Higher prevalence rates among homosexual men correlates with the increased risk of exposure associated with receptive anal intercourse. In addition, high prevalence rates of CMV IgM antibody in longstanding CMV-seropositive homosexual men suggest that this group is frequently re-exposed to (and at least sometimes reinfected with) differing exogenous strains of CMV."

If you're thinking of being tested for syphilis (an excellent idea) be sure your doctor performs a specific treponemal serology like TPHA or FTS-Abs, not just a VDRL or RPR test.

MtD

Could you explain more about why TPHA and FTS-Abs is better? I have no idea what test they used on me. If they did the RPR test and told me I didn't have it, does that mean there is still a possibility I could have it? I need to read up about these tests more. I suppose I could have googled this, but you can probably explain better from your own experience. Aren't there also tests for the Heps, liver, and kidney function that paint a clearer picture than the usual labs that are performed?

Could you explain more about why TPHA and FTS-Abs is better? I have no idea what test they used on me. If they did the RPR test and told me I didn't have it, does that mean there is still a possibility I could have it? I need to read up about these tests more. I suppose I could have googled this, but you can probably explain better from your own experience. Aren't there also tests for the Heps, liver, and kidney function that paint a clearer picture than the usual labs that are performed?

I don't want to hijack this thread with an indepth discussion of syphilis, a particularly complex disease.

I (and others) have discussed the various aspects syphilis on previous occasions so a search of the forums should provide you with more than enough detail.

I will say that TPHA and FTS-Abs are tests which will can tell if a person has been exposed to Treponema Pallidum the bacteria which causes syphilis. You should think of them as analogous to an HIV antibody test.

VDRL and RPR are non-specific in that conditions other than syphilis can return reactive results on those tests. These tests (most notably RPR) are used to determine the progression of syphilitic disease as well as monitoring the efficacy of treatment. In that sense these tests are analagous to the HIV viral load test.

Effective detection and management of syphilis requires a combination of TPHA or FTS-Abs and VDRL or RPR.

I know you have decided against meds for now - but this does sound like one more reason to be on them. I.e. if you were on meds getting another strain of the virus would not be an issue.

Using condoms - and making sure they remain on the dick that is plugging your hole(s) - also means getting another strain is not an issue. Makes more sense than starting treatment when it isn't necessary.

For someone who has already seen out the first few years of their initial infection, I really don't believe reinfection is an issue anyway.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Using condoms - and making sure they remain on the dick that is plugging your hole(s) - also means getting another strain is not an issue. Makes more sense than starting treatment when it isn't necessary.

For someone who has already seen out the first few years of their initial infection, I really don't believe reinfection is an issue anyway.

How about abstinence? That would also work.

Clearly there are Pros / Cons to the treatment debate. This situation sounds like one in the pro bucket - someone is doing everything by the book and yet is facing the risk of reinfection.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Just when I was starting to cheer up a bit--now I'm really depressed. For a day or two I've had something on the back of my mind, and this morning I got up the courage to check it out. It's these articles by Dr. Sonnabend:

They're all about how co-infection with other viruses can speed up HIV progression, and CMV is the star of the show. A few quotes:

"Cytomegalovirus (CMV) may be the most important of the herpesviruses that promote HIV disease progression."

"It is not only through their contributions to immune activation that herpes viruses promote HIV replication. In addition to the pro-inflammatory cytokines that have this effect, herpes virus gene products can directly activate HIV if a cell is infected with both viruses. This process, called transactivation works both ways; HIV can also activate herpes viruses.

In addition, herpes infections cause a receptor (Fc) to appear on cell surfaces that allows HIV to enter it. In this way cells that do not possess CD4 molecules can become infected with HIV. Active CMV infections can also exert a mildly immunosuppressive effect.

Herpesviruses, particularly CMV are singled out because they probably play a significant role in the pathogenesis of HIV disease."

And most chilling of all:"CMV infections are so common that it is hard to find HIV infected individuals who are free from it so that they can be compared to those who are not. But as early as 1991 this was done with HIV infected hemophiliac patients, when it was noted that those also infected with CMV had a much more rapid progression of their HIV disease."

To someone who's just been infected with CMV---this is terrifying stuff to read!

Is there anything one can do?

It looks like I should change the title of this thread to "CMV". Or "Re-infection and CMV: two excellent reasons not to have sex."

I believe that's talking about active CMV infection. Like the acute illness you experienced, or when it becomes a problem in late-stage, untreated hiv infection.

For example, other herpes viruses like zoster or simplex can be latent, or dormant, in the system. They're considered active when they cause shingles or blisters. I'm thinking this may be the case here too. Worth looking into further.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

CMV is nasty. My (deceased) ex died blind due to it. From the start in 1992, I too tested positive for CMV, but managed to dodge getting sick from it. From 1998 through 2001, when I had no measurable CD4's and VL hovering in the upper 3millions, I had to go to the Ophthalmologist every 6 weeks for precautionary ocular dilated fundus examination. Thank heavens I was and remained clean.Nowdays with a more than decent CD4 count, I only go in for an eye checkup every other year.

During my revolving hospital door days, I've met others who were not so lucky regarding CMV, as it can strike anywhere in the body.

You can go on making youself crazy about what may or may not happen, or you can relax and have your eyes periodically checked. If you ever get sick, and the ailment is not immediately known, have your doc's double check the CMV titers. Otherwise there is little you can do, other than start HAART and hope your CD4's rise to a safe level.

Please remember that with the meds nowdays, we're only seeing death and blindness due to CMV in people who are diagnosed very late in infection, don't have access to meds or won't take them when indicated. For people who have access to meds and start treatment when they need to, CMV is not the horror story it was in the dark pre-HAART days.

Don't let yourself get worked up too much over CMV, Nestor. Remember, the majority of us poz people have it - including me.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

But to be fair, it's orders of magnitude off. There have been about 100 billion people ever born. So the percentage should be more like 99.999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999% maybe more 9s

But to be fair, it's orders of magnitude off. There have been about 100 billion people ever born. So the percentage should be more like 99.999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999% maybe more 9s

I believe that's talking about active CMV infection. Like the acute illness you experienced, or when it becomes a problem in late-stage, untreated hiv infection.

For example, other herpes viruses like zoster or simplex can be latent, or dormant, in the system. They're considered active when they cause shingles or blisters. I'm thinking this may be the case here too. Worth looking into further.

Well, I just spent a few hours re-reading the three Sonnabend articles. (By the way, Dr. Sonnabend is just one of the most informative and interesting writers about HIV out there! But sometimes it's a little difficult for me to follow the argument.) Anyway, most of the article sounds as if he's simply talking about having CMV, any CMV, in your system, but then he writes: "Once acquired, CMV, as with all herpes viruses, remains present for life. The infected individual will produce antibodies against the virus. However not all those who are CMV antibody positive are actively infected as measured by detecting CMV virus itself in blood or body secretions by culturing it or by techniques like PCR. Periodic reactivation however does occur.

Using such techniques it is possible to compare HIV disease progression in people with or without active CMV infections.

As early as 1986 an article published in AIDS Research which I was then editing suggested a correlation of CMV viremia with a poor prognosis for HIV infected individuals. Since then several additional studies have suggested the same thing.

It is difficult to know what comes first; are active CMV infections accelerating HIV disease or is it the other way around? It's most certainly both, and I'll address this later."

Later on he emphasizes the importance of using condoms for people with HIV--for the purpose of avoiding re-infection with active CMV, which would accelerate the progression of HIV!

Please remember that with the meds nowdays, we're only seeing death and blindness due to CMV in people who are diagnosed very late in infection, don't have access to meds or won't take them when indicated. For people who have access to meds and start treatment when they need to, CMV is not the horror story it was in the dark pre-HAART days.

Don't let yourself get worked up too much over CMV, Nestor. Remember, the majority of us poz people have it - including me.

Thanks a lot for the encouragement. I've come around to being a bit less gloomy about things. After all, this only means that I've joined the ranks of the vast majority of HIV+ people who already have CMV. And if my body has dealt with HIV for close to six years now, it's hard to believe that it won't be able to manage another virus. And yet, a few things are still making me nervous. For one thing, this CMV must be pretty powerful stuff! When I got HIV six years ago I went through some sero-conversion symptoms, but it was nothing like the past month!

I know you have decided against meds for now - but this does sound like one more reason to be on them. I.e. if you were on meds getting another strain of the virus would not be an issue.

You're absolutely right; if you're making a list of pros and cons of starting HAART, this absolutely belongs on the pro side. Someone on HAART does not have to worry about re-infection. For me, however, it does not tip the balance. When I do start HAART I suspect I will have other things to worry about, and being relieved of worry about re-infection does not appear to me to be a good enough reason to give myself those other worries prematurely. (On the other hand, if I were planning to have lots of unsafe sex, then that would be a diferent story.)

You're absolutely right; if you're making a list of pros and cons of starting HAART, this absolutely belongs on the pro side. Someone on HAART does not have to worry about re-infection. For me, however, it does not tip the balance. When I do start HAART I suspect I will have other things to worry about, and being relieved of worry about re-infection does not appear to me to be a good enough reason to give myself those other worries prematurely. (On the other hand, if I were planning to have lots of unsafe sex, then that would be a diferent story.)

I actually posed this question theoretically in a thread where I was asking about HAART individuals being immune to reinfection because their daily dosing essentially acts as a PrEP dose. Did you guys find some information confirming this hypothesis?

I actually posed this question theoretically in a thread where I was asking about HAART individuals being immune to reinfection because their daily dosing essentially acts as a PrEP dose. Did you guys find some information confirming this hypothesis?

I remember when you said that. I did not find information, but I found a lack of it. Specifically, when I thought that re-infection was what had happened to me, I read all those articles in the page I linked to in my original post. There are lots of cases of re-infection, but they're all among people not yet on HAART. Unless I overlooked something (which is possible--I wasn't really reading with this question in mind) I did not see a single mention of someone on HAART getting re-infected. Theoretically it seems it should be possible. You're on atripla, you get re-infected with a strain that's resistant to atripla, and suddenly atripla doesn't work for you any more. But I don't think I noticed a single mention of that sort of thing actually happening, and since that seems to be the definitive collection of articles on the subject, that suggests that it just doesn't happen.

Well couldn't one in theory be exposed to an HIV strain resistant to one's own HAART, and therefore be reinfected?

I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process.I understand that there are viruses out there with individual mutations, but not across-the-board ones.

So if you face a mutated virus, you'd be effectively working against it with a dual or monotherapy as PEP. And I think that's sufficient to prevent infection.

For me, however, it does not tip the balance. When I do start HAART I suspect I will have other things to worry about, and being relieved of worry about re-infection does not appear to me to be a good enough reason to give myself those other worries prematurely. (On the other hand, if I were planning to have lots of unsafe sex, then that would be a diferent story.)

What do you expect to worry about when you start HAART? I've started myself this week actually.

I decided to come up with a short list of reasons to not start. What do you think - which are most important to you?

--Side effects that decrease quality of life today--Unfelt effects on the body that may manifest themselves years later--Having to take the pill every day for foreseeable future--Affordability issues

You said: "I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process."

It's very possible ! There are plenty of people in these forums whose virus' have mutations against all components of the cocktail ( by the way, there are at least 5 components to various medications ie: RT,NNrt, PI, integrase,ccr5 inhibitors). These resistent strains can be transmitted from one poz to another. If anyone is willing to role the dice and take that chance, the consequences could literally be deadly. Let's not kid ourselves.http://aids.about.com/od/treatmentquestions/f/resistinfect.htm

You said: "I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process."

It's very possible ! There are plenty of people in these forums whose virus' have mutations against all components of the cocktail ( by the way, there are at least 5 components to various medications ie: RT,NNrt, PI, integrase,ccr5 inhibitors). These resistent strains can be transmitted from one poz to another. If anyone is willing to role the dice and take that chance, the consequences could literally be deadly. Let's not kid ourselves.http://aids.about.com/od/treatmentquestions/f/resistinfect.htm

You said: "I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process."

It's very possible ! There are plenty of people in these forums whose virus' have mutations against all components of the cocktail ( by the way, there are at least 5 components to various medications ie: RT,NNrt, PI, integrase,ccr5 inhibitors). These resistent strains can be transmitted from one poz to another. If anyone is willing to role the dice and take that chance, the consequences could literally be deadly. Let's not kid ourselves.http://aids.about.com/od/treatmentquestions/f/resistinfect.htm

v

How cute my first accidental double post, can some mod delete this second please? Thanks if you can, np if you can't

"Hi, Is there any evidence that HIV-reinfection does occur? I have been repeatedly asked if 2 HIV positive individuals have unprotected sex, is there any risk of them acquiring each others strains/resistance patterns? Thanks, Cyrus Badshah, MD

On Aug 13, 2002 Joel E. Gallant, M.D., M.P.H. replied:

--------------------------------------------------------------------------------Absolutely. In fact, the most convincing case was presented by Bruce Walker at the Barcelona last month. He reported on a patient who was diagnosed and treated within weeks of infection. The patient then went through some STI cycles, leaving him with strong HIV-specific CTL and CD4 responses. Despite this excellent HIV-specific immunity, he developed a flu-like illness shortly after a high-risk sexual exposure. His viral load went up and he had a decline in his HIV-specific CD4 response. The rebounding virus was analyzed and was found to be different from his original isolate, with only 88% homology by phylogenetic analysis, clearly indicating reinfection. If there was any doubt as to whether this can happen, I think this case put it to rest. It also led to considerable consternation, given the troubling implications it has for vaccine development."

You said: "I think it would be next to impossible. For that to happen, the virus would have to develop mutations for each three components of the cocktail a person is taking - since, as far as i know, each drug targets a different part of the replication process."

It's very possible ! There are plenty of people in these forums whose virus' have mutations against all components of the cocktail ( by the way, there are at least 5 components to various medications ie: RT,NNrt, PI, integrase,ccr5 inhibitors). These resistent strains can be transmitted from one poz to another. If anyone is willing to role the dice and take that chance, the consequences could literally be deadly. Let's not kid ourselves.http://aids.about.com/od/treatmentquestions/f/resistinfect.htm

v

Thank you for the clarification - so such virus strains are out there. What are these people doing as treatment if they have something like that?

Sorry I should've been more specific. If you believe reinfection occurs outside of an acute infection stage. It's difficult to pin down who is reinfected and I'm a little confused on how it is that they test for reinfection considering the test for HIV isn't for the virus itself but for the antibodies to it.